Surgical appliance



May 20, 1958 s. E. BORGESON SURGICAL APPLIANCE- Filed Aug. 14, 1956PULMONARY ARTERY PULMONARY VEIN RIGHT AURICLE LEFT AURIOLE NITRAL VALVELEFT VENTRICLE RIGHT VENTRICLE AORTIC VALVE 'FIG.4.

INVENTOR.

SIDNEY E.BORGESON ozc'u BY FLORENCE W. BORGESON,

' EXECUTRIX BY ATTORNEY United States Patent SURGICAL APPLIANCE SidneyE. Borgeson, deceased, late of Westfield, N. J., by Florence W.Borgeson, executrix, Westiield, N. J.

Application August 14, 1956, Serial N0. 603,896

9 Claims. 01. 128-303) The present invention concerns an improved methodand appliance for performing surgical commissurotorny for aorticstenosis.

Aortic stenosis is essentially a narrowing of the opening between thecusps of the valve that is located at the entrance of the aorta vein. Inone form of heart disease the aortic valve becomes gradually but a smallopening and allows only a fraction of the blood to travel from the heartto the head and body. The constriction at this point causes the blood toback up in the lungs causing pulmonary edema and heart failure.

In recent years surgeons have attempted to enlarge the valve opening inan effort to restore it to normal, or nearly normal, size and function.One method of treatment consisted in the surgeon making a small incisionin the lower part of the heart and, using a blunt ended wire passed intothe ventricle, probing about until he was reasonably certain that thewire found and entered the residual opening in the aortic valve.Thereafter a triangular shaped dilating instrument was slid along thewire and forced into the aortic orifice to cause one or more of thefused commissures of the valve to separate. This was a purelyinstrumental commissurotomy by trans-ventricular passage without benefitof direct palpation of the valve or of accurate visual or digitalguidance of the instruments. However, the operative mortality rate ofpatients treated in this manner remained relatively high mostly fromfailure properly to reach the aortic valve and from hemorrhaging at thesite of the ventricular punctures.

Another approach to the aortic valve was tried by way of the left atriumand the mitral orifice. This procedure involved entering the pulmonaryvein adjacent the heart and inserting a finger and probing for theaortic valve. After the aortic valve was found and digitally dilated thefinger was withdrawn and the incision in the vein sutured. The operationwas at best blind and presumably risky owing to the ever presentpossibility of inadvertently tearing the septa] mitral leaflet andtherefore the practice has not been widely accepted.

Later still another approach to the aortic valve was made directly by anincision in the arch of the aorta vein itself, below the valve. Inpracticing this method of treatment the surgeon inserted his finger andprobed for the opening in the valve. After it was found the dilatinginstrument was guided into the valve orifice with the finger and digitaland instrumental commissurotomy of aortic stenosis was performed in arelatively safe manner.

The present invention concerns more especially, though not exclusively,the last mentioned method and relates more particularly to an improvedmethod and means for gaining access to the aorta and heart without unduedelay. Prior to this invention it was customary for the surgeon to clampa portion of the outer arch of the aorta between the jaws .of a tool andmake an incision in the excluded portion. Thereafter a strip of thepericardium was sutured about the incision so as to form a tubularextension. The surgeon inserted his finger into the tube and thelatterwas secured with a purse string suture about the upper portion of hisfinger. Only after all of these time consuming preliminary operationswere performed was the clamp removed and access to the aorta and itsvalve became possible. i

The present invention concerns a device that may be secured about thesurgeons finger and one or more in strurnents before he approaches thepatient and with the equipment in position the surgeon proceeds with theoperation by placing his cassioned finger upon the aorta and fitting thelower part of the cassion to the curvature circumferentially andlongitudinally. Thereafter a vacuum valve is opened and the cassionclamped securely to the slippery aorta vein. After clamping in thismanner the incision in the aorta is made by a finger-guided knife withinthe sealed-on cassion and thereafter the finger is inserted and thevalve located with certainty. After palpitating the valve digitally forknowledge of the condition, the dilatating instrument is guidedcarefully into the small opening and the valve expanded again to normal.The dilator is then withdrawn into the cassion as well as the surgeonsfinger and a Potts clamp applied to the aorta under the cassion, andthis portion of the aorta is excluded from the flow stream. The vacuumseal is then broken, the cassion removed, and the incision suturedbefore the Potts clamp is removed. The operation, when performed in themanner outlined, consumes only a few precious minutes as against thetime heretofore required in suturing and unsuturing a cassion to andfrom the aorta itself, and indeed with far greater assurance of successthan has ever before been attainable.

Other objects and advantages will be in part indicated in the followingdescription and in part rendered apparent therefrom in connection withthe annexed drawings.

To enable others skilled in the art so fully to aprehend the underlyingfeatures hereof that they may embody the same in the various wayscontemplated by this invention, drawings depicting a preferred typicalconstruction have been annexed as parts of this disclosure and, in suchdrawings, like characters of reference denote corresponding partsthroughout all the views, of which:

Fig. l is a line diagram representing the heart and illustratingdiagrammatically the heart valves and portions of the veins and arteriesconnected therewith.

Fig. 2 is a perspective view of the device of this invention in positionon the aortic vein.

Fig. 3 is an elevational View of the device.

Fig.4 is a plan view of the device.

Fig. 5 is a transverse sectional view taken along line 5-5 of Fig. 4.

Fig. 6 is a bottom view of a portion of the device illustrating moreclearly the marginal suction grooves.

Fig. 7 is a view of the device equipped with a flexible skirt having twooperational openings.

With reference more particularly to Figs. 3 to 6 of the drawings, thedevice comprises preferably a relatively rigid ring member 10 of metalor plastic and an extended skirt or .sleeve portion 11 made ofpreferably flexible material such as sheet rubber or plastic. In thepreferred embodiment the ring member 10 is somewhat comically shaped andformed with a marginal groove 12 about its upper end to provide ananchor for the lower portions of the sleeve i1. Inasmuch as the sleeve11 must not only be securely fastened to the ring 10, but fastenedtightly throughout the perimeter of the cassion member, it was foundadvisible to flare the sides 10a of the cassion outwardly so that theskirt-tying groove 12 took a curved and somewhat oval path about thering member. When the lower portions of the skirt are telescoped overthe grooved ring and overlaid by a tightly drawn cord, no creviceremains for possible seepage of air or liquid from between the skirt andthe ring.

substantially The relatively rigid cassion portion is generallyelongated and provides a generous opening within its margins throughwhich the surgeon may pass a finger and one or more instruments. Thelower end face 16 of the cassion for aortic commissurotomy is shaped soas to conform closely to the normal curvature of the aorta bothlongitudinally and transversely, as indicated at 17 and 18 in Figs. 3and 5. The curvatureof the end face should in any given case match theexterior contour of the vein, artery, or other vessel upon which it isto be used, so that a fairly substantial area of face-to-face engagementis made at the location where the incision and operation is to beperformed.

To effect tight clamping of the finger cassion to the membranousarterial wall, the invention proposes to form one or more annulargrooves 24) in the end face in and when the device is fitted to thevessel in which the incision is to be made, to connect the groove orgrooves with a source of suction. In a preferred form of finger cassion,two annular grooves are provided, the grooves being separated by arelatively narrow partition wall 21. Such a construction, as seen mostclearly in Fig. 5, provides three lines of contact extendinguninterruptedly about the end face of the cassion, which, when appliedto the relatively soft and pliable membrane of the aorta or other vesseland the vacuum applied, causes annular undulations to form in themembrane about the locale of the incision that assist in producing aneffective seal and a firm anchoring of the cassion to the pliable wall.As further assurance against slipping or inadvertent dislodgment of thecassion during the performance of a delicate operation, it is proposedto roughen the end face of the separating wall 21 as by forming shallowserrations therein or by knurling that face as indicated at 22 in Fig.6.

The bottom of the groove or grooves are cross connected by a passageway201: which in turn leads to the exterior of the cassion and forms thebore of a con nection fitting 20b by which the cassion may be con nectedto a source of vacuum.

As illustrated more clearly in Figs. 2 and 3, the upper portion of thecassion sleeve is formed with a pursestring type of closure 25 which maybe shirred and tied about the surgeons finger before placing the cassionon the part to be operated upon. For certain types of operations theinstrument the surgeon will use in making the initial incision and/ orin performing the subsequent operation will also be shirred within thesleeve either with the finger or via a separate opening such asindicated at 25a in Fig. 7.

In using the device of this invention, the surgeon will have first takenall the preliminary steps necessary to expose the vein, artery, or othertube in which the incision is to be made. Thereafter an assistant willshirr the sleeve of the cassion about his finger and such instruments ashe selects. The grooved end face of the cassion is then placed gently onthe exposed vein at the proper location for the operation and the vacuumline opened to exhaust the air from the annular grooves. The operationof exhausting air simultaneously effects a secure clamping of thecassion to the vein and an effective liquid and air-tight seal about themargins. In a matter of instants, as compared with former methods ofsuturing an appendage around the zone of the incision and then suturingthe appendage to the finger, the surgeon is ready to make the incisionworking from within the hermetically sealed cassion. By the presentinven tion the finger cassion is aflixed almost instantaneously withoutneedless stitching and Without expending precious time.

When the commissurotomy has been completed. the finger is again drawninto the cassion and a clamp placed on the vein beneath the cassion toexclude the incised portion from the remainder of the tube. The vacuumaffixing the cassion to the tube is released and the cassion removed,after which the excluded incised portion of the vein is sutured in theregular manner, and the clamp is removed so that the vein again assumesits normal cylindrical form. As above indicated there is no time lost insuturing an appendage to the vein as a preliminary step to acommissurotomy nor is there any time lost in removing such appendage.With the aid of this invention an air lock may be effected around anarea in seconds and the shock to the patient is reduced to its minimum.

Without further analysis, the foregoing will so fully reveal the gist ofthis invention that others can, by applying current knowledge, readilyadapt it for various utilizations by retaining one or more of thefeatures that, from the standpoint of the prior art, fairly constituteessential characteristics of either the generic or specific aspects ofthis invention and, therefore, such adaptations should be, and areintended to be, comprehended within the meaning and range of equivalencyof the following claims.

Having thus revealed this invention, the following combinations andelements, or equivalents thereof are claimed by Letters Patent of theUnited States:

1. A cassion for surgical purposes comprising a ring like member havinga relatively flat end face adapted to engage the surface of themembranous tissue about the zone where a surgical operation is to beperformed, a pliable tubular sleeve member secured at one end to saidring-like member, means at the other end of said tubular sleeve memberfor securing same about a finger of an operator, and means at said flatend face of the ring-like member for attaching the ring-like member tothe tissue to anchor the ring-like member in place and to form a sealabout the incision to be made by the cassioned finger of the operator.

2. A finger cassion for surgical purposes comprising a ring-shapedmember having a continuous side wall defining a central opening throughwhich a surgical operation may be performed, a pliable sleeve membersecured to said ring so as to form a tubular extension thereof, means atthe free end of said pliable sleeve member for securing said end aboutthe finger of the surgeon, means at the open end of said ring-shapedmember for securing the ring to the tissue surrounding the area wherethe surgery is to be performed, said ring-shaped member having itstissue engaging end face contoured substantially complementary to thesurface contour of the area of the surface surrounding the zone selectedfor the operation.

3. A device for assisting a surgeon in performing sur gicalcommissurotomy for aortic stenosis comprising an elongated ring-shapedmember having one end face contoured substantially complementary to thesurface con tour of the aortic vein adjacent the patients heart so as toengage the surface of the vein surrounding the site of the operation,said one end face of the member having an annular groove thereineffectively dividing said end face into at least two perimetrical areasof contact with the surface of the said vein, conduit meanscommunicating with the chamber formed by said groove and leading to theexterior of said ring-shaped member adapted to be connected with asource of vacuum whereby to effect a clamping of the ring member to thevein, and means for sealing the other end of said ring-shaped memberabout the finger of the surgeon and such instruments as may be employedin performing surgical commissurotomy.

4. An air-lock for surgical purposes comprising a relatively rigidtubular-shaped member having an end face adapted to be placed inengagement with tissue surrounding the area where the surgery is to beperformed, vac-uum means for securing said tubular-shaped member to saidtissue including vacuum chambers in said end face of the member adaptedto be connected with a source of reduced pressure, said chambers beingseparated from one another and being open on their sides adjacent thetissue surrounding the area for the surgery so that when placed inposition for an operation such tissue forms a closure to said chambers,portions of said tissue-engaging end face of the member being roughenedto restrain the member against lateral movement on the tissue during thecourse of an operation, and sleeve means sealed about said member forenclosing the operating finger of the surgeon.

5. The combination of claim 4 in which said sleeve means is providedwith an opening for an operating instrument in addition to the fingeropening.

6. A cassion for surgical purposes comprising a metallic member havingan end face adapted to engage the surface of the membranous tissue aboutthe zone Where a surgical operation is to be performed, said memberhaving a central opening through which the operation may be performed, apliable tubular sleeve member secured at one end to said member, meansat the other end of said tubular sleeve member for securing same about afinger of a surgeon, and vacuum means effective at said end face of themember for anchoring the member in place and to form an air lock aboutthe incision to be made by the cassioned finger of the surgeon.

7. A finger cassion for surgical purposes comprising a member having acontinuous side wall defining a central opening through which a surgicaloperation may be performed, a pliable sleeve member secured to saidmember so as to form a tubular extension thereof, means at the free endof said pliable sleeve member for securing said end about the finger ofthe surgeon, means at the open end of said member for securing themember to the tissue surrounding the area Where the surgery is to beperformed, said member having its tissue engaging end face contouredsubstantially complementary to the surface contour of the area of thesurface surrounding the zone selected for the operation, and having atleast one groove extending therearound adapted to be connected with asource of suction.

8. A device for assisting a surgeon in performing surgicalcommissurotomy for aortic stenosis comprising an elongated ring-shapedmember having one end face contoured substantially complementary to thesurface contour of the aortic vein adjacent the patients heart so as toengage the surface of the vein surrounding the site of the operation,said one end face of the member having two annular grooves thereineffectively dividing said end face into at least three perimetricalridges adapted to engage with the said surface of the vein, and conduitmeans communicating with the chambers formed by said grooves and leadingto the exterior of said ring-shaped member adapted to be connected witha source of vacuum whereby to effect a clamping of the ring member tothe veing, and at least one of said ridges in said end face of themember being knurled to resist slipping.

9. An air-lock and seal for surgical purposes comprising a relativelyrigid member having an end face adapted to be placed in engagement withthe tissue surrounding the area Where the surgery is to be performed,said memher having an operating opening therein defined by said endface, vacuum means for securing said member to said tissue includingvacuum chambers in said end face of the member adapted to be connectedwith an exterior source of reduced pressure, said chambers beingseparated from one another and open toward the surface on which themember is placed so that when in position for an operation such tissueforms a closure for said chambers, and means at the other end of saidmember for sealing the member about the finger of the surgeon.

References Cited in the file of this patent UNITED STATES PATENTS

